The Yale Center for Healthcare Innovation, Redesign, and Learning (CHIRAL) is a joint venture of Yale School of Medicine (YSM) and Yale-New Haven Hospital (YNHH) that brings together an expert group of physicians, nurses, industrial engineers, communication experts, informatics specialists, sociologists, simulation researchers, clinical researchers and administrators, creating a dynamic learning environment to improve patient safety. CHIRAL will focus on some of the most perilous moments in healthcare: transitions of care. Patients being transferred from one setting to another or one clinical team to another are at increased risk for a host of failures including identification errors, delayed or missed diagnoses, redundant testing, treatment delays or errors, medication errors, and unexpected clinical deterioration. Yet, ensuring the safety of patients during transitions of care has long been one of the biggest challenges facing the healthcare system. CHIRAL aims to improve patient safety at the time of transition through three interrelated and synergistic project based at YNHH. In the first project, we will redesign transfers of patients into our hospital from outside hospitals and emergency departments (EDs). In the second project, we will redesign transfers within our hospital: between our ED or intensive care unit (ICU) and general hospital units. In the third project, we will redesign transfers out of our hospital to the community. All projects will examine transitions through similar conceptual lenses of shared sense making (a collective ability to make sense of complicated, dynamic and ambiguous information without oversimplifying or ignoring discordant data) and latent systems conditions (considering the influence of workflow, skills, culture, staffing patterns, equipment, incentives and information technology). All projects will take a similar design and engineering approach to clinical redesign, beginning with in-depth problem analysis, then preceding through design (brainstorming), development (prototyping), implementation and evaluation phases. Projects will make use of a central Administrative/Operations core, a Simulations core, and an Informatics core. CHIRAL will be closely aligned with hospital and university quality and safety efforts, which will expand its influence and impact.